THE PRINCIPLES OF DIAGNOSIS AND SURGICAL TREATMENT OF COMPLICATED FORMS OF GALLSTONE DISEASE

Vestnik ◽  
2021 ◽  
pp. 391-394
Author(s):  
В.М. Мадьяров ◽  
М.М. Сахипов ◽  
Г.Р. Жапаркулова
Keyword(s):  
Surgical Treatment ◽  
Gallstone Disease ◽  
Pathological Process ◽  
Abdominal Complications ◽  
Acute Calculous Cholecystitis ◽  
Results Of Treatment ◽  
Calculous Cholecystitis

Проанализированы за последние три года результаты оперативного лечения 200 больных с осложненными формами желчнокаменной болезни. Доказано, что риск возникновения гнойно-деструктивных форм острого калькулезного холецистита зависит от характера патологического процесса в желчном пузыре. По поводу гнойно-деструктивных форм заболевания при острого калькулезного холецистита оперировано 79,7% больных и 38,9% при необструктивной форме холецистита. Риск интраабдоминальных осложнений зависит от наличия обструкции, выявленное у 18,1% больных с обтурационнной и 5,6% у пациентов с необтурационнной формой. Госпитализация при гнойно-деструктивных формах 63,5% пациентов в первые 2 часа и 85,7% в первые 6 часов от момента заболевания, дает возможность своевременно оперировать больных до развития его интраабдоминальных осложнений. The results of treatment of 200 patients with complicated forms of gallstone disease were analyzed. It is proved that the risk of purulent-destructive forms of acute calculous cholecystitis depends on the nature of the pathological process in the gallbladder. For purulent-destructive forms of the disease in acute calculous cholecystitis, 79.7% of patients and 38.9% of patients with non-obstructive form of cholecystitis were operated on. The risk of intra-abdominal complications depends on the presence of obstruction, identified in 18.1% of patients with obstructive and 5.6% in patients with non-obstructive form. Hospitalization with purulent-destructive forms of 63.5% of patients in the first 2 hours and 85.7% in the first 6 hours from the time of the disease makes it possible to timely operate patients before the development of its intra-abdominal complications.

scholarly journals Systemic inflammatory response syndrome (SIRS) in complications of gallstone disease accompanied by mechanical jaundice (review of literature)

2021 ◽  
Vol 179 (6) ◽  
pp. 94-100
Author(s):  
V. E. Fedorov ◽  
N. B. Zakharova ◽  
O. E. Logvina
Keyword(s):  
Systemic Inflammatory Response Syndrome ◽  
Inflammatory Response ◽  
Gallstone Disease ◽  
Clinical Signs ◽  
Pathological Process ◽  
Systemic Inflammatory Response ◽  
Acute Calculous Cholecystitis ◽  
Mechanisms Of Development ◽  
Inflammatory Changes ◽  
Calculous Cholecystitis

At present, the determination of the severity of patients with complications of acute calculous cholecystitis, manifested in the form of mechanical jaundice (MJ), remains an insufficiently studied issue. This is due to the fact that the main attention in the examination of such patients is paid to the diagnosis and assessment of the severity of liver failure, and the signs of SIRS (Systemic Inflammatory Response Syndrome) are not given due attention. In this regard, this literature review presents data on the systemic inflammatory response syndrome in such patients, describes its etiopathogenetic mechanisms of development, presents clinical signs, stages of this pathological process. The role of biomarkers, which can be used to determine the severity of inflammatory changes in the biliary system in MJ, is estimated on the basis of literature data.

scholarly journals ANTIBIOTIC PROPHYLAXIS OF PURULENT AND SEPTICAL COMPLICATIONS DURING SURGICAL TREATMENT OF COMPLICATED GALLSTONE DISEASE ON BACKGROUND OF LIVER CIRRHOSIS

2019 ◽  
Vol 42 (3) ◽  
pp. 41-45
Author(s):  
Khimich S. D. ◽  
Muravyev F. T.
Keyword(s):  
Liver Cirrhosis ◽  
Surgical Treatment ◽  
Antimicrobial Prophylaxis ◽  
Gallstone Disease ◽  
Mirizzi Syndrome ◽  
Acute Calculous Cholecystitis ◽  
Escalation Therapy ◽  
Group 2 ◽  
Calculous Cholecystitis ◽  
Group 1

Purpose of the study. The goal of this investigation was to determine the main risk factors in development of purulent and septical complications during surgical treatment of complicated gallstone disease on background of liver cirrhosis. Materials and methods. We retrospectively reviewed medical records of 247 patients who undergone treatment in minimally invasive surgery centre of Zhytomyr regional clinical hospital during 2009–2018. All patients with complicated gallstone disease were divided in two groups: group 1 – patients with concomitant liver cirrhosis – 79(31,98%), and group 2 – patients without liver cirrhosis – 168 (68,02%). The inclusion criteria were presents of complicated gallstone disease (acute calculous cholecystitis, choledocholithiasis with obstructive jaundice and Mirizzi syndrome), and verified liver cirrhosis. Patients with oncological history, immunodeficiency and morbid obesity were excluded. Liver cirrhosis was staged by Child-Тurcotte-Рugh system. In all cases patient’s condition was assessed by APACHE II scoring system and patients with cirrhotic lesion were additionally analyzed by MELD score. Acute calculous cholecystitis was diagnosed in 185 patients: group 1 – 68(Child A – 36, Child B – 31, Child C – 1), group 2 – 117 patients. The signs of cholodecholithiasis with obstructive jaundice were present in 49 cases: group 1 – 7 (Child A – 5, Child B – 1, Child C – 1), group 2 – 42. Mirizzi syndrome was verified in 9 cases: group 1 – 2 (Child A – 1, Child B – 1, group 2 – 7. Results and discussion. In all patients treatment was started in conservative way that included detoxic, antibacterial and hepatoprotective components. In group of control early operative tactic in cases with acute calculous cholecystitis was preferred. Antimicrobial prophylaxis was performed in cases of severe and moderate calculous cholecystitits with use of cephalosporines of 2 generation in moderate case, and protected cephalosporines of 3 generation in combination with metronidazol in severe. In main group providing of antimicrobial therapy was performed very carefully, because of higher risk of hepato-renal insufficiency. The early de-escalation therapy was mandatory performed. Purulent complications occurred in 13,2% of patient with liver cirrhosis in comparison with control group with 1,7% of complications. Conclusion. The treatment of complicated gallstone disease in patients with liver cirrhosis is very risky in case of postoperative purulent complications. In case of Child A stage of cirrhosis the treatment is safe, and the incidents of purulent complications is the same like in the absence of cirrhosis. Administration of antibiotics in cirrhotic should be very careful because of higher risk of hepato-renal insufficiency. The early de-escalation therapy should be mandatory performed. The «gold» standard of empirical antimicrobial therapy is the use of cephalosporines of 2 and 3 generation. Keywords: gallstone disease, cirrhosis, antimicrobial prophylaxis.

scholarly journals Mortality risk estimation in acute calculous cholecystitis: beyond the Tokyo Guidelines

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Ana María González-Castillo ◽  
Juan Sancho-Insenser ◽  
Maite De Miguel-Palacio ◽  
Josep-Ricard Morera-Casaponsa ◽  
Estela Membrilla-Fernández ◽  
...  
Keyword(s):  
Risk Factors ◽  
Surgical Treatment ◽  
Propensity Score ◽  
Mortality Risk ◽  
Characteristic Curve ◽  
Chronic Obstructive ◽  
Tokyo Guidelines ◽  
Acute Calculous Cholecystitis ◽  
Calculous Cholecystitis ◽  
Non Surgical Treatment

Abstract Background Acute calculous cholecystitis (ACC) is the second most frequent surgical condition in emergency departments. The recommended treatment is the early laparoscopic cholecystectomy; however, the Tokyo Guidelines (TG) advocate for different initial treatments in some subgroups of patients without a strong evidence that all patients will benefit from them. There is no clear consensus in the literature about who is the unfit patient for surgical treatment. The primary aim of the study is to identify the risk factors for mortality in ACC and compare them with Tokyo Guidelines (TG) classification. Methods Retrospective unicentric cohort study of patients emergently admitted with and ACC during 1 January 2011 to 31 December 2016. The study comprised 963 patients. Primary outcome was the mortality after the diagnosis. A propensity score method was used to avoid confounding factors comparing surgical treatment and non-surgical treatment. Results The overall mortality was 3.6%. Mortality was associated with older age (68 + IQR 27 vs. 83 + IQR 5.5; P = 0.001) and higher Charlson Comorbidity Index (3.5 + 5.3 vs. 0+2; P = 0.001). A logistic regression model isolated four mortality risk factors (ACME): chronic obstructive pulmonary disease (OR 4.66 95% CI 1.7–12.8 P = 0.001), dementia (OR 4.12; 95% CI 1.34–12.7, P = 0.001), age > 80 years (OR 1.12: 95% CI 1.02–1.21, P = 0.001) and the need of preoperative vasoactive amines (OR 9.9: 95% CI 3.5–28.3, P = 0.001) which predicted the mortality in a 92% of the patients. The receiver operating characteristic curve yielded an area of 88% significantly higher that 68% (P = 0.003) from the TG classification. When comparing subgroups selected using propensity score matching with the same morbidity and severity of ACC, mortality was higher in the non-surgical treatment group. (26.2% vs. 10.5%). Conclusions Mortality was higher in ACC patients treated with non-surgical treatment. ACME identifies high-risk patients. The validation to ACME with a prospective multicenter study population could allow us to create a new alternative guideline to TG for treating ACC. Trial registration Retrospectively registered and recorded in Clinical Trials. NCT04744441

Surgical treatment of acute calculous cholecystitis followed by one-day discharge of patients

2019 ◽  
pp. 32
Author(s):  
F. S. Kurbanov ◽  
M. A. Chinikov ◽  
Yu. G. Aliev ◽  
R. Kh. Azimov ◽  
L. R. Alvendova ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Acute Calculous Cholecystitis ◽  
Calculous Cholecystitis

scholarly journals Carbuncle - the actual problem of modern surgery (Literature review)

2019 ◽  
Vol 21 (4) ◽  
pp. 19-24
Author(s):  
K V Lipatov ◽  
Yu E Cherkasov ◽  
V I Khrupkin ◽  
M V Lysenko ◽  
E I Dekhissi
Keyword(s):  
Surgical Treatment ◽  
Literature Review ◽  
Plastic Surgery ◽  
Pathological Process ◽  
Tissue Viability ◽  
Actual Problem ◽  
Surgical Interventions ◽  
Timely Diagnosis ◽  
Results Of Treatment ◽  
Surgical Tactics

Analyzed the features of the surgical treatment of carbuncles. The severity of the purulent-necrotic process was assessed, the significance of the timely diagnosis of the inflammatory stage and the choice of the timing of surgical treatment is shown. The features of the options of surgical tactics - from gentle to radical surgical interventions, methods of intraoperative assessment of tissue viability in the inflammatory focus are described. The necessity of a differentiated approach to the treatment of carbuncles depending on the stage of the disease, the prevalence of the pathological process and its localization is substantiated. The significance of restorative skin-plastic surgery in the replacement of postnecrectomy defects of epithelial tissues in the treatment of extensive carbuncles is shown. Ways of improving the results of treatment of patients with carbuncles are outlined, including timely diagnosis, a differentiated approach to surgical treatment, rational antibacterial therapy, and adequate general treatment.

Mortality Risk Estimation in Acute Calculous Cholecystitis: Beyond the Tokyo Guidelines

2021 ◽  
Author(s):  
Ana-María González-Castillo ◽  
Juan Sancho-Insenser ◽  
Maite De Miguel-Palacio ◽  
Josep-Ricard Morera-Casaponsa ◽  
Estela Membrilla-Fernández ◽  
...  
Keyword(s):  
Risk Factors ◽  
Surgical Treatment ◽  
Propensity Score ◽  
Mortality Risk ◽  
Characteristic Curve ◽  
Chronic Obstructive ◽  
Tokyo Guidelines ◽  
Acute Calculous Cholecystitis ◽  
Calculous Cholecystitis ◽  
Non Surgical Treatment

Abstract Background: Acute Calculous Cholecystitis (ACC) is the second most frequent surgical condition in Emergency Departments. The recommended treatment is the Early Laparoscopic Cholecystectomy, however, the Tokyo Guidelines (TG) advocate for different initial treatments in some subgroups of patients without a strong evidence that all patients will benefit from them. There is no clear consensus in the literature about who is the unfit patients for surgical treatment. The objective of the study is to identify the risk factors for mortality in ACC and compare them with Tokyo Guidelines (TG) classification.Methods: retrospective unicentric cohort study of patients emergently admitted with and ACC during January 1, 2011 to December 31, 2016. The study comprised 963 patients. Primary outcome was the mortality after the diagnosis. A propensity score method was used to avoid confunding factors comparing surgical treatment and non-surgical treatment.Results: the overall mortality was 3.6%. Mortality was associated with older age (68 + IQR 27 vs. 83 + IQR 5.5; P 0.001) and higher Charlson Comorbidity Index (3.5 + 5.3 vs. 0+2; P 0.001). A logistic regression model isolated four mortality risk factors (ACME): chronic obstructive pulmonary disease (OR 4.66:95%CI: 1.7-12.8 P=0.001), dementia (OR 4.12;95%CI: 1.34-12.7 P=0.001), age > 80 years (OR 1.12:95% CI: 1.02-1.21 P=0.001) and the need of preoperative vasoactive amines (OR 9.9:95%CI: 3.5-28.3 P=0.001) which predicted the mortality in a 92% of the patients. The receiver operating characteristic curve yielded an area of 88% significantly higher that 68% (P=0.003) from the TG classification. When comparing subgroups selected using propensity score matching with the same morbidity and severity of ACC, mortality was higher in the non-surgical treatment group. (26.2% vs. 10.5%).Conclusions: mortality was higher in ACC patients treated with non-surgical treatment. ACME identifies high-risk patients. The validation to ACME could allow us to create a new alternative guideline to TG for treating ACC.Trial Registration: retrospectively registered and recorded in Clinical Trials (NTC 0474441).

Advanced forms of kidney tuberculosis with fistula formation: modern views

2020 ◽  
pp. 60-69
Author(s):  
Andrey Volkov ◽  
Oleg Zuban ◽  
Galina Saenko
Keyword(s):  
Surgical Treatment ◽  
Pathological Process ◽  
Long Term Results ◽  
Fistula Formation ◽  
Results Of Treatment ◽  
Internal Fistulas ◽  
Intestinal Fistulas ◽  
Kidney Lesions

The aim of the study is to evaluate results of surgical treatment in patients with tuberculous pyonephrosis. In 2004 - 2019 12 patients underwent nephroureterectomy. The disease was complicated by involvement of nearby organs in pathological process and appearance of spontaneous external and internal fistulas in 100% of cases, it manifested with symptoms mostly not associated with kidney lesions. Reno-intestinal fistulas were found intraoperatively in 5 patients. Good long-term results of treatment were achieved mainly due to surgical debridment.

scholarly journals SIMULTANEOUS SURGERIES IN BARIATRIC SURGERY (LITERATURE REVIEW)

2021 ◽  
Author(s):  
Yuri V. Ivanov
Keyword(s):  
Bariatric Surgery ◽  
Morbid Obesity ◽  
Surgical Treatment ◽  
Hernia Repair ◽  
Paraesophageal Hernia ◽  
Ventral Hernia Repair ◽  
Anterior Abdominal Wall ◽  
Gallstone Disease ◽  
Paraesophageal Hernia Repair ◽  
Calculous Cholecystitis

Based on the available publications, the article presents an analysis of studies on the problem of simultaneous execution of cholecystectomy, ventral and paraesophageal hernia repair during bariatric intervention. If there is a clinical picture of chronic calculous cholecystitis, simultaneous cholecystectomy is justified and does not lead to a significant increase in the number of complications. In case of asymptomatic stone-bearing disease, the optimal tactic remains controversial, both surgical treatment and observation are possible. In the absence of gallstone disease, all patients after surgical correction of excess weight are shown to take ursodeoxycholic acid, while performing preventive cholecystectomy is not recommended. Simultaneous ventral hernia repair is justified only for small defects ( 10 cm) of the anterior abdominal wall. If a paraesophageal hernia is detected in patients with morbid obesity, bariatric surgery may be combined with cruroraphy.

scholarly journals Long-term results of surgical treatment of calculous cholecystitis with the use of mini-access

2014 ◽  
Vol 21 (1) ◽  
pp. 67-69
Author(s):  
R. A. Sopiya ◽  
A. A. Popov ◽  
A. J. Korobov ◽  
E. R. Sopiya
Keyword(s):  
Surgical Treatment ◽  
Clinical Laboratory ◽  
Long Term Results ◽  
Acute Calculous Cholecystitis ◽  
Sf 36 ◽  
Instrumental Methods ◽  
Calculous Cholecystitis

The paper presents the follow-up results of the mini-access surgery for chronic calculous cholecystitis (72 patients) and for calculous cholecystitis (133 patients) performed 3-6 years ago. The long-term results were estimated on two international questionnaires of quality of life (SF-36, GSRS), and on the data of clinical, laboratory and instrumental methods of investigation. All patients operated on for chronic calculous cholecystitis had good long-term results. 99.3 % of the patients with acute calculous cholecystitis had good and satisfactory results of surgical treatment. Only 1 (0.7 %) patient had an unfavourable result, because of choledocholithiasis, identified 2 years after surgery.

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